CT angiography for the detection and characterization of carotid artery bifurcation disease
CT angiography for the detection and characterization of carotid artery bifurcation disease
复制标题
DOI：
10.1161/01.str.31.9.2168
复制
发表时间：
2000-09-01
期刊：
影响因子：
8.3
通讯作者：
Findlay, JM
中科院分区：
文献类型：
--
作者：
Anderson, GB;Ashforth, R;Findlay, JM
背景和目的-计算机断层血管造影（CTA）是一种相对较新的颅内和颅外血管成像的微创方法。本研究的主要目的是比较CTA与目前动脉成像的金标准数字减影血管造影术（DSA）检测和量化颈动脉分叉狭窄。我们还比较了多普勒超声（US）与这2 techniques. Methods，在前瞻性研究中，40例患者（80颈动脉）进行了CTA，US和DSA。入选的患者有TIA或中风的症状，并进行了初始US筛选，表明在适合症状的一侧颈动脉狭窄>50%。源轴向，最大强度投影（MIP），和表面遮盖显示（SSD）图像的CTA研究。审查US、CTA和DSA图像，量化狭窄程度并确定是否存在溃疡;每种类型的成像均由一名单独的研究者审查，该研究者对其他2种模式的结果不知情。结果CTA源轴位图像与DSA图像的相关性优于MIP或SSD图像。US与DSA的相关性（0.808）低于CTA与DSA的相关性（0.892 ~ 0.922）。CTA在检测轻度（0%至29%）颈动脉狭窄以及颈动脉闭塞方面表现良好，敏感性、特异性和准确性接近100%。在通过DSA测量确定狭窄>50%时，CTA再次有用，其敏感性、特异性和准确性分别为89%、91%和90%。虽然CTA在识别50%至69%或70%至99%范围内的狭窄程度方面具有相当的特异性和准确性，但在这项任务中，其灵敏度要低得多：50%-69%狭窄为65%，70%-99%狭窄为73%。当仅分析最具临床相关性的症状性动脉的数据时，这些结果没有显著变化。CTA被认为是一个很好的相关性与DSA在检测相关的溃疡与颈动脉stenosis. Conclusions-CTA被认为是一个很好的检查颈动脉闭塞的检测和狭窄的分类在0%-29%或>50%的范围。然而，CTA无法可靠地区分中度（50%-69%）和重度（70%-99%）狭窄，这是颈动脉狭窄调查和治疗的重要限制。
Background and Purpose-Computed tomographic angiography (CTA) is a relatively new and minimally invasive method of imaging intracranial and extracranial blood vessels. The main purpose of this study was to compare CTA to the current gold standard of arterial imaging, digital subtraction angiography (DSA), for the detection and quantification of carotid artery bifurcation stenosis. We also compared Doppler ultrasound (US) with these 2 techniques.Methods-In a prospective study, 40 patients (80 carotid arteries) underwent CTA, US, and DSA. patients chosen for inclusion were symptomatic with TIAs or stroke and had initial US screening that indicated >50% carotid stenosis on the side appropriate for the symptoms. Source axial, maximum intensity projection (MIP), and shaded-surface display (SSD) images were produced for each CTA study. The US, CTA, and DSA images were reviewed, with the degree of stenosis quantified and presence of ulcers determined; each type of imaging was reviewed by a separate investigator blinded to the results of the other 2 modalities. The results of CTA and US imaging were compared with the DSA images for degrees of carotid stenosis.Results-CTA source axial images correlated with DSA more closely than MIP or SSD images for all degrees of stenosis. The correlation between US and DSA (0.808) was poorer than that between CTA and DSA (0.892 to 0.922). CTA performed well in the detection of mild (0% to 29%) carotid stenosis, as well as carotid occlusion, with values for sensitivity, specificity, and accuracy near 100%. In determining that a stenosis was >50% by DSA measurement, CTA was again useful, with a sensitivity, specificity, and accuracy of 89%, 91%, and 90%, respectively. While CTA was quite specific and accurate in identifying degrees of stenoses in either the 50% to 69% or the: 70% to 99% ranges, in this task it was much less sensitive: 65% for 50%-69% stenosis and 73% for 70%-99% stenosis. These results did not change significantly when only the data from the most clinically relevant symptomatic arteries were analyzed. CTA was found to correlate quite well with DSA in the detection of ulcers associated with the carotid stenosis.Conclusions-CTA was found to be an excellent examination for the detection of carotid occlusion and categorization of stenosis in either the 0%-29% or >50% ranges. However, CTA was unable to reliably distinguish between moderate (50%-69%) and severe (70%-99%) stenosis, which is an important limitation in the investigation and treatment of carotid stenosis.